Doctor of Medicine: Clinical Applications All Other Years Clerkships

INTL 9110 Tropical Medicine Rotation to Madagascar

Application process: Application should be made with the Internal Medicine Department of Western Michigan University, Homer Stryker, MD, School of Medicine.

Contact:  Richard R. Roach, MD, FACP, Internal Medicine Faculty, Western Michigan University School of Medicine. Three orientations are required. The first relates to culture and geography [supper is provided to make sure you enjoy Malagasy food]. The second relates to schedule and expectations [a review of the daily schedule and check on completion of reading assignments]. The third has to do with packing and preparation [did you get all your vaccinations? Leave your hair dryer at home, etc.]. The rotation is offered during Block IV [Septermber-October]. Tel: 337-6396   



  1. Develop confidence in physical exam, assessment of clinical course and relate to patients with different cultural values from the physician.
  2. Develop confidence in assessing tropical diseases recognizing the regional specificity of tropical diseases.
  3. Develop an understanding of Travel Medicine and competence to provide instructions to patients traveling to third world countries.
  4. Develop a comfort level of understanding a patient with different cultural values and expectations

Objectives: This rotation will familiarize the resident with common tropical diseases, public health issues in developing countries, poverty related disease and research being done in tropical medicine.  It will provide an opportunity to work in a cross-cultural environment, with patients who do not speak English.

INTL 9110 Section 2 - Amazon Region of Northern Peru
Thomas Melgar, MD

This four-week rotation during block 9 (Mid February - Mid March).  Participants will travel to Iquitos, Peru.  The first two weeks will be spent in Iquitos at local hospitals and health care centers working with local physicians on inpatient and outpatient services.  At least one day will be spent in the lab working with local technicians on diagnostic testing of tropical diseases.  At least one day in Iquitos will be spent doing outreach clinics to the underserved population of the city.  After completion of the first week the team will move to a remote location up the Amazon river to a tributary of the Yarapa river which will serve as our base.  From there the team will visit 15-20 villages providing primary and urgent care to patients of all ages.  Students will have an opportunity to work in our mobile lab and to work with portable ultrasonography.  The team will be conducting multiple research projects and students will be able to participate in the development and implementation of those projects.

Offered: Block 9 only (Mid February – Mid March)


After completion of this elective, each student will be able to:

  1. Obtain a medical history and perform a physical examination appropriate to the patient’s presentation
  2. Construct a logically thought out, prioritized, differential diagnosis for problems typically seen in this tropical environment
  3. Construct a diagnostic and management plan appropriate to a resource poor environment
  4. Draw upon a strong foundation of knowledge of disorders seen in this region of the tropics
  5. Draw upon clinical experience with disorders seen in this region of the tropics
  6. Understand and order appropriate testing for tropical diseases
  7. Draw upon cultural competency from working with the native populations of the region
  8. Construct a problem list for public health in remote communities

B. Conditions typically encountered

1.     Presenting Problems

a.     Fever

b.     Rash

c.      Diarrhea

d.     Headache

e.     Dizziness

2.     Diseases/syndromes

a.     Parasitic infections of the gastrointestinal tract

b.     Skin disorders

c.      Upper respiratory infections

d.     Musculoskeletal problems

e.     Pterygium and refractive errors

f.      Malaria

g.     Dengue

h.     Zika

i.       Yellow fever

j.       Scarlet fever

k.     Rheumatic fever

l.       Leptospirosis

m.   Leishmaniasis

n.     Tuberculosis

o.     Malnutrition

p.     Dehydration


C. Typical schedule, activities, and events:  Schedule varies by location. In each location there will be at least one day off each week.  In Iquitos days typically are from 8 am until 4 pm.  In the jungle typically days begin at 7 am heading out by boat for 30-120 minutes to villages.  Approximately 4-5 hours of clinical time is spent working in the villages with a one hour lunch break and returning to the lodge between 3 and 5 pm. Management of clinic data and research project data can be done on the boats or at the lodge after the clinic day. Educational lectures will be provided by participants in the morning or evening. Late afternoon and evening is free time.  Participants may relax, read, swim, canoe or go on guided nature hikes. Each night an attending physician, a resident physician and student is on call for patients brought to us at the lodge after hours.  Students may ask to participate in the care of these patients but are not required.


D. Assigned reading/educational references:  Will be provided to the team once selected in the months prior to the trip


E. Assessment plan, criteria, and standards:  All participants will receive verbal feedback throughout the rotation and a direct one on one midpoint verbal evaluation. A complete written evaluation will be provided at the end of the rotation.


F. Evaluation of the elective:  All participants are expected to provide written feedback of the rotation.


G.  Other: 

1.     The Amazon Rainforest is a beautiful but harsch environment and accommodations in the lodge are rustic and not handicapped accessable. Think rustic camping. Applicants should be comfortable with this.

2.     Participants will need to provide proof of proper immunizations and prophylaxis based on the CDC international travel recommendations.

3.     Participants must have a valid passport and must be able to re-enter the USA.

4.     The cost of the elective varies but will be approximately $3,700

a.     Including:

                                                                 i.     Airfare to Iquitos

                                                                ii.     Lodging in Iquitos and in the Jungle

                                                               iii.     Food and water for all meals in the jungle

                                                               iv.     Daily breakfast in Iquitos

                                                                v.     Transportation to and from the jungle lodge and to the villages

                                                               vi.     Evacuation insurance

b.     Not included:

                                                                 i.     Transportation in Iquitos (approximately $1-2/day)

                                                                ii.     Food and water in Iquitos other than breakfast ($10-$15/day)

                                                               iii.     Immunizations and prophylactic medications

                                                               iv.     Personal expenses

5.     Spanish fluency is not required but is very helpful.  Translators are available.

6.     Optional one on one Spanish language instruction is available at an additional cost.

7.     Ultrasonography training and skill is beneficial.

8.     Each member of the team is expected to help transport up to 50 pounds of medical supplies by using one of their two free checked bags for this purpose.

9.     Space is limited: Students and residents must apply and be selected.  The application can be found at the following link:

10.  The application is due by June 1st 2018 and decisions will be announced by June 30th 2018.


SURG 8110 Surgery Clerkship

The third year core surgery clerkship will expose students to a variety of surgical experiences. The students will be assigned to the resident services at Bronson Methodist Hospital or Borgess Medical Center. They will have a preceptor that will mentor them and where the student will gain outpatient experience. They will be exposed to a variety of general surgery inpatient procedures and patients. The student will spend one week on night float to learn about management of emergent surgical diseases. 

The students will be expected to attend academic surgical conferences and will have assigned readings. The summative evaluation will be composed of direct clinical observations by preceptors, oral examinations, a standardized patient and a bioskills portion. Upon the completion of the clerkship students should have a basic knowledge of many common surgical diseases and be comfortable knowing which patients need referral to a surgeon. The students should also be comfortable with sterile technique and basic suturing.


Upon completion of the Surgery Clerkship the third year student shall be able to:

  • Acquire History and Physical Exam skills, which lead to accurate assessment and planning of Surgical Care.
  • Demonstrate competent skill in basic surgical techniques knowing the proper application of those skills.
  • Describe common disease processes in standard treatments that include common core surgical considerations.
  • Develop knowledge, skills, attitudes and behaviors toward learning, which perpetuate lifelong learning, inquisitiveness and evidence-based practice.
  • Communicate with peers, mentors and allied health care personnel in an effective and professional manner.
  • Collaborate with peers, mentors and allied health care personnel in an effective and professional manner.
  • Describe typical postoperative care, including common complications of common core procedures.
  • Discuss the roles of medical students on the Surgery Clerkship and the role of Surgeons in health care delivery.
  • Demonstrate behaviors consistent with the highest standards of professionalism and medical ethics in all patient encounters.
  • Demonstrate professional behaviors when interacting with patients, families, and all members of the health care team (including physicians and non-physician health professionals)
  • *Adapted from the University of Kansas School of Medicine’s reduced version of the Association for Surgical Education’s objectives.